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Biomedical subjects

D Payne

Publications and source records attributed to D Payne.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

A pilot study of interpersonal psychotherapy by telephone with cancer patients and their partners.

A single-arm pilot study explored the feasibility of adapting in Interpersonal Psychotherapy (IPT) by telephone to reduce psychological distress and to enhance coping during cancer treatment. Therapy focuses on role transitions, interpersonal conflicts, and grief precipitated by cancer. Breast cancer patients receiving high-dose chemotherapy received weekly sessions with a psychologist throughout chemotherapy and for 1 month afterwards. Patients could invite one 'partner' to receive individual telephone IPT. Psychosocial functioning was assessed using standardized measures at study entry, after chemotherapy, and following telephone IPT. Accrual and participation supplied evidence of feasibility: 14 patients and 10 partners were recruited, 82.5% of those eligible. Patients had a mean of 16 sessions; partners had a mean of 11. Participants rated their satisfaction with the program between 'good' and 'excellent'. A test of the efficacy of telephone IPT requires a larger, randomized trial. In order to standardize the intervention, a treatment manual was developed. This study indicated the importance of outreach to family members as well as to cancer patients, intensive patient education about oncology treatment and the medical care setting, and psychosocial services that continue after cancer treatment has been completed.

Adaptation, Psychological↗
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Radiotherapy in the management of non-small-cell lung cancer.

Radiation plays an important role in the management of patients with non-small-cell carcinoma of the lung. Understanding the impact of radiation on this tumor and on normal tissues requires a knowledge of the natural history of the tumor, and of basic sciences, including radiation physics and biology. This review gives a brief outline of the scientific basis of radiotherapy, followed by a discussion of some practical issues concerning radiation tolerances of tissues within the thorax, the acute and late sequelae of radiation, and the treatment planning process. The role of radiotherapy is explored in the following settings: Radical radiation with curative intent for early stage disease, adjuvant mediastinal irradiation for completely resected tumors, radiation of known residual disease after surgical resection, preoperative radiation, prophylactic cranial radiation, radiation of locally advanced unresectable disease, and, finally, radiation with palliative intent in patients with metastatic disease. Pertinent studies, with the emphasis on randomized trials, are outlined to document the present state of understanding with respect to the impact of radiation in each of these situations. Several of the controversies in this area are addressed, with particular emphasis on selection of patients for high-dose radiation and recent results of combined modality treatment with radiation and chemotherapy.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Patient regrets after bilateral prophylactic mastectomy.

BACKGROUND: The discovery of a cadre of breast cancer susceptibility genes has resulted in an increase in the number of women seeking information about prophylactic breast surgery, but virtually no large-scale prospective databases exist to assist women considering prophylactic mastectomy. METHODS: The authors constructed a National Prophylactic Mastectomy Registry comprised of a volunteer population of 817 women from 43 states who have undergone prophylactic mastectomy. RESULTS: In the registry, 370 women had undergone bilateral prophylactic mastectomy. Twenty-one (5%) women expressed regrets about the procedure. The median follow-up was 14.6 years (mean 14.8 years; range 0.2-51 years). Those with regrets were subsetted into those with major (n = 10) or minor (n = 7) regrets. Regrets were more common in those women with whom discussion about prophylactic mastectomy was initiated by a physician (19/255), compared with patients who initiated the discussion themselves (2/108; P < .05). CONCLUSIONS: The overall satisfaction rate of 95% reported here may be explained by the voluntary nature of this registry. The most important factor that predicts an unfavorable outcome following bilateral prophylactic mastectomy is a physician-initiated discussion.

Adult↗
PubMedDate not supplied

Susceptibility of Plasmodium falciparum in vitro to chloroquine, mefloquine, quinine and sulfadoxine/pyrimethamine in Somalia: relationships between the responses to the different drugs.

The susceptibilities of Plasmodium falciparum to chloroquine, mefloquine, quinine and sulfadoxine/pyrimethamine were investigated in Mogadishu in 1988, after chloroquine resistance had spread widely in Somalia. Possible correlations of the responses to these drugs were also investigated. Standard World Health Organization in vitro micro-tests were performed. Of 76 isolates tested for chloroquine susceptibility, 58 (76%) were resistant to the drug with mean EC50 and EC99 values of 1.06 x 10(-6) mol/litre and 10.44 x 10(-6) mol/litre of blood, respectively, indicating a high prevalence and degree of resistance. In contrast, all isolates tested were inhibited by mefloquine 3.2 x 10(-6) mol/litre of blood, quinine at 2.56 x (-6) mol/litre of blood-medium mixture, and sulfadoxine/pyrimethamine at 6.0/0.075 x 10(-6) mol/litre of blood-medium mixture, indicating full sensitivity to these 3 drugs. However, a significant positive correlation was found between responses to quinine and chloroquine and between those to quinine and mefloquine; the responses to chloroquine and mefloquine were not correlated. The results may suggest that sites responsible for the correlation are shared between quinine and chloroquine but not essentially between chloroquine and mefloquine. Thus the evolution of chloroquine resistance together with increased use of quinine treatment of P. falciparum may increase the risks of development of quinine resistance, whereas the development of mefloquine resistance would not be triggered by chloroquine resistance.

Animals↗
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A lens too far?

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Developing Countries↗
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Children's hospitals collaborate to improve quality of care.

The Child Health Accountability Initiative brought together 35 chief executive officers, physicians, and researchers representing 12 children's hospitals and charged them with what most would think is a lofty goal: to improve health outcomes for America's children. After a rigorous and often highly debated selection process, two data-driven performance improvement projects were rapidly set in motion and implemented in each of the hospitals, with significant results--all within the first year. The initiative's breadth, scope, and speed may serve as a model for other healthcare collaboratives.

California↗
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Early surgery versus conservative management of dissecting aneurysms of the descending thoracic aorta.

BACKGROUND: Optimal management for patients who present acutely with uncomplicated type III dissections of the descending thoracic aorta remains controversial. Patients with dissecting aneurysms represent a subgroup at high risk of rupture who may benefit from early elective surgery as an alternative to standard medical therapy. METHODS. The authors constructed a Markov decision model to compare the following clinical strategies: 1) early elective surgery immediately after diagnosis (EARLY SURGERY), 2) medical therapy with periodic computed tomography and with elective surgery when aortic diameter is projected to reach 6 cm (CT FOLLOW-UP), and 3) medical therapy with urgent surgery for dissection-related complications (WATCHFUL WAITING). Data sources included Medline (1966-1995) and a case series of patients with type III dissecting aneurysms who received medical therapy with radiographic follow-up. RESULTS: For a typical 60-year-old patient with an acute, uncomplicated 5-cm dissecting aneurysm of the descending thoracic aorta and an operative 30-day mortality rate of 14% for EARLY SURGERY, the model predicts that EARLY SURGERY improves survival compared with CT FOLLOW-UP (9.91 vs 9.44 QALYs). Conservative management may be preferred for patients who have maximum aneurysm diameters < or = 4 cm, are elderly (> or = 75 years), or have higher-than-expected risk of operative mortality. CONCLUSIONS: The choice between early surgery and medical therapy for uncomplicated dissecting aneurysm of the descending thoracic aorta should be tailored to the individual patient's operative risk, risk of dissection-related events, and age. Early surgery may be a reasonable alternative to medical therapy for carefully selected patients at centers with favorable perioperative mortality rates.

Acute Disease↗
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Recovery time.

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Absenteeism↗
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Watching the waiting.

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Bed Occupancy↗